POS0931 USEFULNESS OF MUSCULOSKELETAL ULTRASOUND IN CLINICAL DECISION-MAKING IN RHEUMATOLOGY CLINICAL PRACTICE
Authors: M. Serrano Warleta, A. Palomeque Vargas, R. Manzo, C. Guillén-Astete
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Ultrasound (US) has proven to be a useful technique in the routine clinical practice of rheumatologists. Due to its low cost, accessibility, and the large amount of information it provides us, more and more ultrasound studies tend to be carried out. However, we wonder about the real clinical-ultrasound correlation and whether, after a given result, the clinician made decisions based on said result. <h3>Objectives</h3> To describe the reason for request of the sonographic studies in our department and the effect of its result in the decision-making in the clinical practice. <h3>Methods</h3> Cross-sectional, observational analytical study. We enrolled all the patients that were cited in the ultrasonography agenda from march to august 2022. Variables for identification of request-exploration-review management times, motivation for the request, topography of the exploration performed, correlation with clinical suspicion and effect on decision-making were collected. Data extraction was performed by four different observers. Quality control was performed by a fifth observer. <h3>Results</h3> Records of 462 medical actions were included in the US agenda over 6 months. Including double requests (211 were bilateral scans), the results of 673 US scans performed were reviewed. Of the requests made, 118 (25.5%) were from patients with known diagnoses of inflammatory diseases. The attached Table 1 summarizes the reasons for the request and topography of the exploration of the studies carried out. The waiting time and standard deviation (SD) until the test was performed from its request was 85.4 SD 54.3 days (0;574) and until the reassessment in the office was 37.5 SD 43.4 days (0;217). The diagnostic correlation of US and clinical suspicion was confirmed in 277 studies (59.2%), it was not demonstrated in 161 (34.4%) and did not apply in the rest. The frequency of bilateral studies whose result could have been obtained with a unilateral exploration was 37/211 (17.5%). In 72 studies we could not determine to what extent US examination changed clinical decision (review query not available or not applicable). In 132 studies (33.8%) the clinician intensified the treatment, in 40 (10.2%) the clinician de-intensified the treatment, and in 63 (16.1%) the clinician indicated the discharge of the patient. Among those cases in which US modified the clinical decision, the time between test-requesting and decision-making was 120.1 SD 64.3 days, while in cases in which there was no effect on the clinical decision it was 160.9 SD 61.3. (p=.0031). Evaluating only the US scans indicated in inflammatory pathology, the times were 66.5 DE 32.5 and 84.3 DE 29.5 days, respectively (p=.0012). <h3>Conclusion</h3> Our study is limited to identifying bivariate associations between decision making and the result of a complementary test. The authors recognize that clinical decisions are made considering all available information, including those from specific complementary test. US proves to be a useful test in clinical decision-making and presumably more so the less time elapses between its request and its interpretation. In addition, performing bilateral US scans seems justified as less than a fifth of the requests would have given the same result with a unilateral scan. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.